Collaborative Communication as the Foundation for Quality Healthcare

Nov 23

by Christina Onolaja, MHA

The Institute of Medicine defines primary care as “the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual's health and wellness needs across settings and through sustained relationships with patients, families, and communities”.

To align insurance carriers, healthcare providers, and patients’ perception of quality healthcare, the first step is to build relationships among the three entities through more collaborative communication.

Frequently each of these entities make healthcare decisions without consideration for the other involved parties which can result in disjointed care. For example, a patient presents to their provider with an illness and the provider prescribes a new medication. The patient goes to the pharmacy to pick up their prescription only to find their insurance denied coverage because they do not feel it is necessary and there may be cheaper options.

The patient is likely now frustrated and feels they did not receive quality care because their problem is not resolved. The provider is annoyed because they have to either justify the prescription they ordered or prescribe something else which consumes time they do not have. The insurance carrier is probably pleased because they did their part to reduce the cost of healthcare.

So who is responsible for owning collaborative communication?

Does one entity have to take the lead? If so, who?

The answer is, all involved entities are responsible. In this case, the process is broken. Many primary care organizations are creating care coordination programs with a goal of dedicating a team of staff members who can work with all parties to ensure quality care is provided to the patients.

The first thing the care coordination team does is establish a relationship with the patient to understand what their healthcare needs are and build trust. Once a relationship is built, the patient feels comfort knowing there is a single person they can contact to discuss their health needs.

In the example above, the patient could contact the care coordinator to let them know their medication request was declined. The coordinator would work with the insurance carrier or healthcare provider to resolve the issue or prescribe a new medication.

The coordinator will also be intimately aware of the patient's physical and mental health condition. Through open communication with the patient and primary care provider, they will learn if there are social determinants of health (SDOH) preventing the patient from being healthy such as lack of financial resources to buy prescriptions, provide transportation to appointments, or buy groceries.

The coordinator can work with community resources, insurance carriers, and the patient care team to address these concerns. The coordinator can also assist with connecting patients to other care providers based on referrals from their primary care.

This is one example of how primary care practices can create solutions to bridge the communication gap between healthcare providers, insurance carriers, and patients. While it does require additional resources and a financial investment, it shares the responsibility between all parties and reduces some of the burden on the provider.

The patient benefits from additional resources. The insurance carrier is happy because better communication results in higher quality care for the patient which can reduce hospital admissions and lower the cost of healthcare. Opening lines of communication between insurance carriers, healthcare providers, and patients can be challenging, but through programs like care coordination, it is possible to establish more collaborative communication.